Shun-Qian Wen1, Qiu-Hui Hu2, Ming Wan3, Sheng Tai3, Xue-Yi Xie1, Qing Wu1, Shang-Lin Yang1, Guan-Qun Liao4. 1. Department of Hepatobiliary Surgery, Affiliated Foshan Hospital of Southern Medical University, Wei Guo Road North, Foshan, 528000, China. 2. Department of Hepatobiliary Surgery, Heilongjiang Province Second Cancer Hospital, Harbin, China. 3. Department of General Surgery, The Second Hospital Affiliated to Harbin Medical University, Harbin, China. 4. Department of Hepatobiliary Surgery, Affiliated Foshan Hospital of Southern Medical University, Wei Guo Road North, Foshan, 528000, China. guanqunliiao@sina.com.
Abstract
BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) is being increasingly used for management of common bile duct (CBD) stones. Primary CBD closure has been reported to have better short-term outcomes compared to T-tube placement. However, primary CBD closure cannot be performed in all patients. AIM: This study aims to evaluate the short- and long-term outcomes of LCBDE with primary CBD closure in appropriately selected patients and compare them with T-tube drainage. METHODS: Retrospective analysis of patients undergoing LCBDE in our department from June 2011 to October 2014 was performed. Primary closure was performed in 52 patients (group A), and a T-tube was placed in 33 patients (group B). Patient demographics, intraoperative findings, postoperative stay, complications, and long-term follow-up data were recorded and compared. RESULTS: The mean operating time was much longer in group A compared to group B (113.92 vs. 95.92 min, p = 0.032). The overall complication rate (9.6 vs. 6.3%, p = 0.701) and hospital stay (4 vs. 5.11 days, p = 0.088) were similar in both groups. No patient required conversion to the open procedure. Bile leakage was more frequent in group A (5.78 vs. 0%, p = 0.279), but this was not statistically significant. All three patients with bile leakage were treated successfully by conservative measures and gradual drain withdrawal. On long-term follow-up, recurrent stones were detected in two patients in group A. No patient was found to develop CBD stricture. CONCLUSION: LCBDE and primary CBD closure has excellent short- and long-term outcomes when performed in appropriately selected patients.
BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) is being increasingly used for management of common bile duct (CBD) stones. Primary CBD closure has been reported to have better short-term outcomes compared to T-tube placement. However, primary CBD closure cannot be performed in all patients. AIM: This study aims to evaluate the short- and long-term outcomes of LCBDE with primary CBD closure in appropriately selected patients and compare them with T-tube drainage. METHODS: Retrospective analysis of patients undergoing LCBDE in our department from June 2011 to October 2014 was performed. Primary closure was performed in 52 patients (group A), and a T-tube was placed in 33 patients (group B). Patient demographics, intraoperative findings, postoperative stay, complications, and long-term follow-up data were recorded and compared. RESULTS: The mean operating time was much longer in group A compared to group B (113.92 vs. 95.92 min, p = 0.032). The overall complication rate (9.6 vs. 6.3%, p = 0.701) and hospital stay (4 vs. 5.11 days, p = 0.088) were similar in both groups. No patient required conversion to the open procedure. Bile leakage was more frequent in group A (5.78 vs. 0%, p = 0.279), but this was not statistically significant. All three patients with bile leakage were treated successfully by conservative measures and gradual drain withdrawal. On long-term follow-up, recurrent stones were detected in two patients in group A. No patient was found to develop CBD stricture. CONCLUSION:LCBDE and primary CBD closure has excellent short- and long-term outcomes when performed in appropriately selected patients.
Entities:
Keywords:
Common bile duct; Common bile duct exploration; Common bile duct stone; Laparoscopic surgery; Primary closure; T tube
Authors: A Cuschieri; E Lezoche; M Morino; E Croce; A Lacy; J Toouli; A Faggioni; V M Ribeiro; J Jakimowicz; J Visa; G B Hanna Journal: Surg Endosc Date: 1999-10 Impact factor: 4.584